‘Country is collapsing’: hospitals in Lebanon overwhelmed by Covid wave


At dawn on Sunday, the moment that the director of intensive care Georges Juvelekian dreaded has finally arrived. His hospital no longer had respiratory assistance devices called BiPaps. It was up to his colleague to choose which of the two patients to treat with only one available machine.

As chairman of the ethics committee of Saint George Hospital, Dr Juvelekian had drawn up a protocol eight months ago on “how to allocate scarce resources”. At the time, The coronavirus epidemic in Lebanon was contained – he expected politics to dust off. But now, for the first time, one of Lebanon’s three largest university hospitals did not have the necessary equipment to help keep someone alive.

With everything from equipment to medicines in short supply, Lebanese doctors say they are on the verge of the “Italy scenario” – making life and death decisions about who should receive scarce medical resources then that coronavirus cases increase after the Christmas holidays.

More than 1,000 people died from Covid-19 in Lebanon in January. A total of 2,477 people in Lebanon have lost their lives to the virus since the start of the pandemic. The government has instituted a 24-hour curfew. With few exceptions, people are prohibited from leaving their homes, relying on supermarket deliveries. “We are currently a low-resource country,” said Dr Juvelekian. “The whole system is on the verge of breaking down.

As many countries grapple with hospital bed shortages and the need to prioritize care, Lebanon’s response has been hampered by the financial crisis that has lasted for over a year and the explosion at the port of Beirut, which devastated the city, partially destroying four hospitals, including Saint George.

Lebanon remains in the hands of an interim administration as its political leaders failed to appoint a new government after the previous one resigned after the August 4 explosion.

The political stalemate and government inaction have made the World Bank, which last week granted its first loan for the purchase of vaccines in Lebanon, unusually brutal. “Our feeling is that the country is falling apart,” said Saroj Kumar Jha, regional director. He described the economic crisis, rooted in years of state mismanagement and alleged political corruption, as “self-inflicted”.

Two weeks after the start of a strict, inconsistently enforced lockdown, Lebanon’s intensive care units are 94 percent full, according to Firass Abiad, director of Rafik Hariri University Hospital, Lebanon’s largest public hospital. The whole country is affected: Dr Wael Harb, deputy medical director of a specialized Covid-19 unit managed by Médecins Sans Frontières in the Bekaa valley, one hour from Beirut, said he was receiving calls from the capital “for intensive care beds, which we don’t have”.

With so many patients, intensive care specialists in Saint George last week ran out of oxygen outlets and had to resort to cylinders. “We hooked people up to oxygen in their cars. That’s how serious it was. We had critical patients sitting in chairs, ”recalls Dr Juvelekian in his office.

Families of Covid-19 victims are desperately seeking hospital spaces, “calling to find out where they know people.” . . if the hospital would accept them, ”said Mazen el Sayed, director of clinical operations in the emergency department of the American University of Beirut Medical Center (AUBMC).

At AUBMC, “patients had to be treated in the corridors[and]. . . in the [emergency department] entry, ”said Dr. Sayed. She is retraining her staff to strengthen her intensive care team. “But honestly … it’s not enough,” he added.

Many are caring for parents at home, fueling a black market in ventilators – with used devices up to $ 7,500 online – and other equipment.

Only patients admitted to agitated emergency departments face the prospect of dying away from their families, said Toufic Chaaban, a specialist in pulmonary and intensive care. He hands iPads to the dying so they can see their families one last time. “It’s better than nothing,” he said.

Meanwhile, Dr Juvelekian says he’s running out of drugs, a side effect of the financial crisis. The Lebanese pound has lost 80 percent of its value against the official exchange rate and, in the past, common pharmaceutical imports have become incredibly expensive. The central bank is burning its hard currency reserves to subsidize medical supplies, but shortages are widespread.

The coronavirus explosion and wave have exposed weaknesses in the patchwork of healthcare providers in Lebanon. Many medical staff receive reduced or delayed salaries. Hospitals find it difficult to retain doctors; hundreds have emigrated.

Volunteers fill in the gaps. More than 80 percent of Lebanese hospitals are private, but 80 percent of emergency ambulance services are provided by Lebanese Red Cross volunteer staff, said its secretary general, Georges Kettaneh.

They are on the front line of the pandemic: in the first 20 days of January 2021 alone, Red Cross ambulances transported around 3,200 Covid-19 patients, almost as many as during the period from February to August 2020.

A Covid-19 patient receives treatment at Rafik Hariri University Hospital © Bilal Hussein / AP

Red Cross volunteers dress in protective gear before transporting coronavirus patient to Beirut hospital © Ayat Basma / Reuters

Even as Covid-19 patients overwhelmed intensive care units, protesters in Lebanon’s second private city, Tripoli, clashed with security forces on Wednesday over the lockdown for the third night in a row.

State media, which reported that one man was killed, said 226 civilians and soldiers were injured when the clashes escalated into riots. Lebanon has been rocked by mass protests since a protest movement gathered momentum in late 2019, but deaths are rare.

Security forces used tear gas and water cannons, while protesters told local media that officers in riot gear fired live ammunition during an altercation. Lebanese Internal Security Forces did not comment on the use of live ammunition, but said they were attacked with stones and hand grenades as protesters attempted to break into at least one building. government.

Economic pain – growth contracted 19% last year – has made it difficult to enforce lockdowns and is fueling anger over the 24-hour curfew put in place in mid-January. About half of the population fell Under the poverty line.

Economic pressure meant that the interim government removed most restrictions when expats armed with hard currency arrived at Christmas. People “went to events and dinners. . . as if we were normal [life]”Kettaneh said, adding that the current wave of viruses was” their fault “.

Yet on Monday, Beirutis in the streets around Saint George spilled out in the January sunshine, lining up outside bakeries. During the weekend, the snow on Lebanon’s famous cedars proved irresistible; traffic was reported on roads leading to hill stations.

This news “made my blood run cold,” said Dr Juvelekian, who can’t remember the last time he had a day off. He begged people to stay home, “I can’t keep doing this. . . we are exhausted.

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